Digital otoscopy versus microscopy: How correct and confident are ear experts in their diagnoses?

Abstract

Introduction With the growing popularity of telemedicine and tele-diagnostics, clinical validation of new devices is essential. This study sought to investigate whether high-definition digital still images of the eardrum provide sufficient information to make a correct diagnosis, as compared with the gold standard view provided by clinical microscopy. Methods Twelve fellowship-trained ear physicians (neurotologists) reviewed the same set of 210 digital otoscope eardrum images. Participants diagnosed each image as normal or, if abnormal, they selected from seven types of ear pathology. Diagnostic percentage correct for each pathology was compared with a gold standard of diagnosis using clinical microscopy with adjunct audiometry and/or tympanometry. Participants also rated their degree of confidence for each diagnosis. Results Overall correctness of diagnosis for ear pathologies ranged from 48.6-100%, depending on the type of pathology. Neurotologists were 72% correct in identifying eardrums as normal. Reviewers' confidence in diagnosis varied substantially among types of pathology, as well as among participants. Discussion High-definition digital still images of eardrums provided sufficient information for neurotologists to make correct diagnoses for some pathologies. However, some diagnoses, such as middle ear effusion, were more difficult to diagnose when based only on a still image. Levels of confidence of reviewers did not generally correlate with diagnostic ability.

Microscope and micro‐camera assessment of Schneiderian membrane perforation via transcrestal sinus floor elevation: A randomized ex vivo study

“…The industrial expansion of telemedicine has resulted in the development of many new tools/devices to overcome surgical limitations and achieve better clinical outcomes (Moberly et al, ). However, this technological revolution must be supported by sound evidence.…”

Diagnostic accuracy and confidence for otoscopy: Are medical students receiving sufficient training?

“…Additional training should incorporate the manual use of the otoscope so that students can gain skill in obtaining an appropriate diagnostic view of the eardrum. The images used in this study have been used previously to assess diagnostic skills of fellowship‐trained neurotologists, resulting in overall diagnostic accuracy rates approaching 80% using an overall more challenging set of images, so we know that the relatively poor diagnostic ability scores of the participants in this study were not simply due to poor image quality …”

“…This device is an all‐in‐one handheld digital otoscope with a liquid crystal display viewfinder that the operator uses to aid in collecting the image, and which provides an on‐screen display of images for immediate review. The 72 images used in this study were a subset of 210 images used in a previous study of diagnostic accuracy in neurotologists . These 72 images had a single primary diagnosis as determined by the neurotologist, and participants were asked to pick the best single answer from the following six choices: normal, ear tube, perforation, tympanosclerosis, eardrum retraction, and middle ear effusion (Fig.…”

“…The 72 images used in this study were a subset of 210 images used in a previous study of diagnostic accuracy in neurotologists. 12 These 72 images had a single primary diagnosis as determined by the neurotologist, and participants were asked to pick the best single answer from the following six choices: normal, ear tube, perforation, tympanosclerosis, eardrum retraction, and middle ear effusion (Fig. 1).…”

“…1). The incidence of the different pathologies within the set of images was as follows: normal (18, 25%), ear tube (six, 8.33%), perforation (12,16.67%), tympanosclerosis (12,16.67%), eardrum retraction (12,16.67%), and middle ear effusion (12,16.67%). Figure 2 presents representative examples of these six diagnostic choices.…”